Full Court "Pressor"
This vasopressor acts on both alpha-1 and beta-1 adrenergic receptors, thus producing potent vasoconstriction as well as a modest increase in cardiac output. First line pressor for the treatment of septic shock and cardiogenic shock. Brand name is Levophed.
What is norepinephrine?
Inhibits thromboxane A2-mediated platelet activation. Loading dose has to be chewed and swallowed immediately upon diagnosis of ACS.
What is aspirin?
HR < 60 bpm. Normal P wave. Sinus bradycardia with BP 85/46. Patient reports feeling tired, lightheaded, and dizzy. The medication used to treat this would be ineffective in heart transplant patients due to lack of vagal innervation.
Dosing: 0.5 to 1 mg every 3 to 5 minutes, 3mg maximum total dose.
What is atropine?
Potent beta-1 adrenergic receptor activity and moderate beta-2 and alpha-1 adrenergic receptor effects. Most often used for the treatment of anaphylaxis, as a second line agent in septic shock, and for management of hypotension following coronary artery bypass grafting (CABG).
What is epinephrine?
Class of medications that decreases risk of ventricular arrhythmias and sudden cardiac death in early post-MI period. Decreases HR and myocardial oxygen demand and increases diastolic filling time of ventricles, thereby improving oxygen flow through the coronary arteries. Should be imitated within the first 24 hours of an ACS unless one of three contraindications are met that must be documented in the medical record.
What is beta-blocker or beta-blockade?
IV beta-1 specific antagnoist with the shortest half life. Elimination is via plasma esterases. Disadvantage: administration rates commonly coincide with high volumes of fluid.
What is esmolol?
This vasopressor has potent, direct-acting alpha-adrenergic agonist activity with virtually no beta-adrenergic activity. MAP is augmented by raising systemic vascular resistance (SVR). Recommended initial vasoactive management of cardiogenic shock due to aortic stenosis, mitral stenosis, or dynamic left ventricular outflow tract obstruction.
What is phenylephrine?
Bare metal stent versus drug eluding stent anti-platelet and P2Y12 antagonist duration of therapy.
What is 1 month (minimum, 12 months preferred) of P2Y12 antagonist plus aspirin for life for BMS versus P2Y12 antagonist for a least 12 months and aspirin for life.
Class III antiarrhythmic that can be used for a variety of arrhythmias (most notably AF/AFl). Renal elimination. ECG monitoring should be performed for safety and tolerability 2-3 hours after the first 5 doses when initiating, reinitiating, or introducing another interacting QT-prolonging agent.
What is sotalol and dofetilide? Name at least one.
This vasopressor is primarily used as a second-line agent in refractory vasodilatory shock, particularly septic shock. It is also used occasionally to reduce the dose of the first-line agent in septic shock. Dosing is not weight based for septic shock, runs at a set rate of 0.03 units/minute.
What is vasopressin?
Inhibits ADP-mediated platelet activation at P2Y12 receptor. Recommended holding duration before CABG is 7 days. Contraindicated in patients with any history of stroke or TIA because of bleeding risk. Patients with a lean body weight (<60kg) should receive a 5mg daily maintenance dose.
What is prasugrel?
Used for both atrial and ventricular tachyarrhythmias. Safe for use in patients with structural heart disease (CHF) because of neutral effect on mortality. Affects all phases of the action potential (Na, Ca, K) and provides some alpha and beta-antagnosim. Severe hypotension can occur with IV formulation of this drug because of the solvent polysorbate 80 (Tween 80) used in some formulations. Large volume of distribution and prolonged half life.
What is amiodarone?
This vasopressor has receptors present in the renal, splanchnic (mesenteric), coronary, and cerebral vascular beds. The primary adrenergic receptor subtype activated by this drug is dose-dependent. In the landmark trial SOAP II, this drug was associated with a significantly higher mortality rate than norepinephrine with or without dobutamine in patients with cariogenic shock.
What is dopamine?
Indicated only for ventricular tachyarrhythmias. Efficacy and toxicity are both concentration dependent. Routine concentrations should be monitored in most patients if this drug is to be continued beyond 24 hours. Dosing is a bolus dose followed by a continuous infusion.
What is lidocaine?